Diffuse Goiter and Severe Hypothyroidism due to Metastasis to the Thyroid

Despite the fact that the thyroid is a highly vascularized organ, clinically significant metastatic spread to the thyroid is considered uncommon. Hypothyroidism due to these metastases seldom occurs. A 68-year-old female patient came to our department because of rapid enlargement of the lower anterior part of the neck, which developed within 2 months. She had a history of poorly differentiated esophageal adenocarcinoma diagnosed 4 years ago, for which she underwent surgical removal of the neoplasm and received three cycles of chemotherapy. On physical examination, the clinical diagnosis was hypothyroidism with large, diffuse, firm goiter, and enlarged firm and fixed cervical lymph nodes. Thyroid and cervical ultrasound examination revealed significant diffuse enlargement of the thyroid, which was heterogeneous and hypoechogenic without focal lesions and multiple pathologically enlarged cervical lymph nodes. Laboratory examination revealed increased TSH levels with decreased free T4 and T3 levels. Fine needle aspiration biopsy of the thyroid revealed a metastatic adenocarcinoma. Our patient received external beam radiation therapy and chemotherapy, but unfortunately she passed away 4 months after diagnosis. Therefore, in case of a new (focal or diffuse) lesion in the thyroid gland in a patient with a history of malignant disease, regardless of the time elapsed since the diagnosis of the primary neoplasm, relapse of the preexisting disease must be considered until proven otherwise

Vitamin D and glycemic control in diabetes mellitus type 2

Objectives: The extraskeletal effects of vitamin D have attracted considerable interest. Vitamin D deficiency appears to be related to the development of diabetes mellitus type 2 and the metabolic syndrome. Vitamin D may affect glucose homeostasis, vitamin D levels having been found to be inversely related to glycosylated hemoglobin levels in gestational diabetes mellitus. In addition, vitamin D appears to protect from the development of gestational diabetes mellitus. The aim was to study levels of 25-hydroxy vitamin D 3 [25(OH)D 3 ] and the relationship between 25(OH)D 3 levels and glycemic control in patients with diabetes mellitus type 2. Methods: Glycosylated hemoglobin (HbA1 c ) and 25(OH)D 3 levels were measured in a group of 120 diabetes mellitus type 2 patients. The same measurements were performed in a group of 120 control subjects of the same age and sex. 25(OH)D 3 was measured by radioimmunoassay and glycosylated hemoglobin (HbA1 c ) was measured by high-performance liquid chromatography. Results: 25(OH)D 3 levels were lower in the diabetes mellitus type 2 patients than in the control group, being 19.26 ± 0.95 ng/ml and 25.49 ± 1.02 ng/ml, in the patient and control groups, respectively ( p < 0.001, Student’s t -test). 25(OH)D 3 levels were found to be inversely associated with HbA1 c levels in the diabetic patients ( p = 0.008, r 2 = 0.058, linear regression). 25(OH)D 3 levels were found to be inversely associated with HbA1 c when the patient and control groups were analysed together ( p < 0.001, r 2 = 0.086). Conclusions: Vitamin D levels appeared to be lower in diabetes mellitus type 2 patients than in the control group, vitamin D levels being related to glycemic control in diabetes mellitus type 2. These findings may have therapeutic implications as cautious vitamin D supplementation may improve glycemic control in diabetes mellitus type 2